Abstract
We describe a case of pancreatic tumor associated with a giant type IV hiatal hernia that had prolapsed into the posterior mediastinum. We initially performed hiatal hernia repair, followed by laparoscopic distal pancreatectomy, because the hernia repair enables performing pancreatectomy safety and in the normal anatomical position.
Keywords: hiatal hernia, pancreatic tumor, distal pancreatectomy
Introduction
Acquired hiatal hernia is classified according to the location of the gastroesophageal junction and the extent of the hernia. In type I or sliding hernia which are the most common hernias, only the gastroesophageal junction is herniated into the posterior mediastinum. In the type II hernias, the gastric fundus is herniated into the mediastinum adjacent to the esophagus, even though the gastroesophageal junction is in the correct position. In type III (mixed) hiatal hernia, more than 30% of the stomach is herniated with the gastroesophageal junction [1]. In type IV giant hernias (0.3%) and congenital hernias (0.2%), organs other than the stomach are herniated. The most frequently herniated organs include the colon, small intestine, omentum and spleen [2] [3]. Intra-abdominal organs, such as the transverse colon, can herniate along with the stomach; however, herniation of the pancreas is very rare.
In simultaneous hiatal hernia repair and distal pancreatectomy, understanding the anatomical features is difficult because of the displacement of the pancreas. Moreover, thus far, no studies have reported cases of neoplastic lesions in a prolapsed pancreas.
We present the case of an elderly patient with a pancreatic tumor associated with a giant type IV hernia that had prolapsed into the posterior mediastinum and required resection. We also present a literature review on surgical treatment of this rare disease.